Monthly Archives: June 2020

Dry Eye Disease

Dry eye disease is a condition in which the eyes do not get adequate lubrication from tears. This condition prevents the eye from removing dust or foreign objects that irritate the eye. As a result, the eyes feel very uncomfortable.

Irritated and injured red eye.

In healthy eyes, the cornea will continue to flow through the tears as the eyes flicker, to nourish the corneal cells and protect the cornea from the outside. Tears are a compound of fat, water, mucus, and more than 1500 proteins that keep the surface of the eye smooth and protected from the surrounding environment, irritating elements, or germs that cause infection. When the glands around the eyes are unable to produce enough tears or when the composition of the tears changes, then the outer surface of the eye that plays a role in transmitting light into the eyes can also be disturbed.

Another name for dry eye disease is keratoconjunctivitis sicca or dry eye syndrome. Dry eyes are more common in women than in men, and the risk of dry eye is also increasing with age.

Dry Eye Symptoms

Common symptoms of dry eye disease include:

  • Red eye.
  • The eyes are hot.
  • The eyes are sandy and dry.
  • Eyes water because of the body’s response to dry eye irritation.
  • Sensitive to sunlight.
  • Blurred vision
  • It’s hard to open your eyes when you wake up, because the upper and lower eyelids are tight.
  • There is mucus in or around the eyes.
  • Have trouble wearing contact lenses or driving at night.
  • The eyes are tired quickly.

The degree of dryness of the eyes varies from mild to severe. But in most cases, the symptoms are still mild.

Dry eye symptoms can worsen when the patient is in certain conditions, such as working on a computer screen for hours, staying in a dry environment, or reading books for long periods of time. Dry eye conditions can cause inflammation on the surface of the eye, resulting in scar tissue in the cornea or bacterial infection.

Causes of Dry Eyes

Some conditions can cause dry eye, which is:

  • Tear production decreased. This condition can be due to old age, certain diseases (such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren syndrome, thyroid hormone disorders, vitamin A deficiency or xerophthalmia), consumption of certain drugs (such as antihistamines, decongestants, antidepressants, hypertension drugs, acne medicine, Parkinson’s disease, or hormone replacement therapy), tear gland damage or radiation.
  • Tears evaporate faster. These conditions can be due to weather (wind, smoke, or dry air), conditions that rarely blink (when reading or working too long in front of a computer screen), eyelids that turn outward (ectopion) or turn inward (entropion).
  • Unbalanced tear composition. Tears are made up of 3 compositions, namely oil, water, and mucus, with a specific composition. When this composition changes, for example due to oil gland blockage, blepharitis, or rosacea, it can cause dry eyes.

In addition to some of the causes of dry eye, the risk of having dry eyes on someone is also increased if:

  • Age over 50. As we grow older, tear production tends to decrease.
  • Experiencing hormone changes. This condition is most common in women who experience hormone changes due to pregnancy, family planning, pills, and menopause.
  • A diet with low vitamin A content.
  • Wear contact lenses.

Dry Eye Diagnosis

To determine the diagnosis of dry eye, the ophthalmologist will ask about the patient’s symptoms and history of their illness, before conducting a physical examination.

To measure the volume of a patient’s tears, the doctor will perform a Schirmer’s test. Through this test, the doctor will measure the degree of dryness in the eyes by sticking to a special piece of paper that can absorb the fluid in the lower eyelids for 5 minutes. Eyes are classified as dry if the wet paper size is less than 10 millimeters in 5 minutes.

While looking at the condition of the eyes, tests using eye drops containing a special dye (fluorescein dye test) can be done. After giving the eye drops to the patient, the doctor can see the color change pattern on the eyes to see how quickly the eyes can dry. This fluorescein dye test can also show areas that have damaged the surface of the eye.

To see the damage to eyebrows can also be seen through a lissamine green test or a special dye on a piece of paper. Next, the paper is washed with saline solution and applied to the surface of the eye. Through a color pattern that attaches to the surface of the eyeball, the doctor can see the early signs of damage to the eye. In addition to eye examination, physical examination will also be done to find out the cause of dry eye,

Dry Eye Treatment

Dry eye treatment is intended to help the patient alleviate symptoms and resolve the cause of dry eye. If the cause of the dry eye is related to a medical factor, the first step to take is to address the cause. For example, if the cause is a side effect of the medication, then the doctor may recommend that the patient replace the drug that does not cause side effects.

For dry eyes that are light or occasional, patients may use eye drops or known as artificial tears, in the form of eye drops, gels, or ointments that are sold free in pharmacies. These medications can moisturize the eyes and act as a substitute for tears.

In addition, other efforts can be made at home to relieve symptoms or prevent dry eye syndrome, namely:

  • Protects the eye from environments that cause dry eyes, such as windy, hot, smelly, or dusty weather. Avoid the environment or use glasses as a protective device, and use an indoor moisturizer or filter.
  • Avoid wearing makeup on the eyes.
  • Stop smoking.
  • Set the length of your work in front of your computer screen.
  • Maintain eye hygiene by applying warm compression to the glands in the eye area, and removing dirt or oil on the eyelids.
  • Many take omega-3 fatty acids which can improve dry eye condition. Omega-3 is found in many types of fish, such as mackerel, tuna, sardines, or salmon.

If home remedies do not work, then doctors can make several therapeutic options, including:

  • Medicines. One of the most commonly prescribed medications to treat dry eye is an antibiotic to relieve inflammation at the ends of the eyelids and over-the-counter painkillers (such as ciclosporine or corticosteroids) that reduce inflammation in the cornea of ​​the eye. However, long term consumption of corticosteroids may have side effects. In order to encourage tears production, doctors can prescribe cholinergic drugs, such as pilocarpine. If the dry eye is still intact, the doctor may recommend using eye drops made and processed from the person’s blood (autologous serum eye drops).
  • LipiFlow thermal pulsation. This tool aims to break down the oil glands that cause dry eyes. During this therapy, tools such as bowls are inserted into the eyes, giving a gentle, warm massage to the lower eyelids,
  • Intensed-pulsed light therapy. Light therapy followed by a massage on the eyelids can help severely dry eye patients.
  • Custom contact lens. These contact lenses called scleral lenses are recommended for patients to protect the surface of the eye and maintain eye moisture.
  • Surgery. This procedure can be done in cases of severe dry eye and cannot be remedied by other therapies. The operation is done by clogging the tear duct permanently, so that the surface of the eye is always moist. Another operation is gastric gland autotransplantation. In this procedure, the saliva gland from the bottom of the lip is raised to be placed in the skin around the eyes to act as a replacement for the tears gland.

In general, dry eye symptoms can be controlled post-treatment. However, there are some patients who still suffer from dry eye syndrome after treatment, even if the complaint lasts a lifetime.

Dry Eye Complications

The possible complications of dry eye disease include increasing the risk of eye infections due to a lack of tears, loss of surface area due to dry eye conditions that are left untreated to cause conjunctivitis, corneal surface damage, open corneal injury, and vision impairment. Dry eye syndrome also causes problems for the sufferer to perform daily activities, such as reading or driving a vehicle.